Inside the Psychiatric Hospital

I invited Karen Jung to write today’s blog. Karen just completed her first-year field practicum for her Social Work Master’s degree at a psychiatric hospital. Her insights are central to the theme of this blog.

A scene from One Flew Over The Cuckoo's Nest (1975)

After days of orientation, I still had no idea what I was getting myself into. The images of "psych wards" in my head were inspired by what I’d seen in One Flew Over The Cuckoo's Nest (1975) and It's Kind of a Funny Story (2010).

No one really knows what goes on in psych units. It's certainly not a place people would volunteer to visit. Mental illness carries a huge stigma in our society, eliciting negative images and stories, particularly with recent mass shootings.

Throughout my year of training, my perceptions about mental illness and mental health care changed. Now I’d suggest that people seek this opportunity because it provides a critical understanding of the elements needed for providing good mental health care.

As a social work intern, I was charged with meeting patients individually in order to complete psychosocial assessments, contacting family members and outpatient providers to obtain collateral information, and conducting family meetings.

The very first patient I met was an African-American woman in her 50’s. She had a dual diagnosis of mental illness (schizophrenia, paranoid type) and substance abuse. Her daughter, in her 30s, came in for a family meeting to assess her mother's progress. The daughter was a nurse at a psych unit at another hospital in the area. She told me that she decided to become a psych nurse because of her mother. She knew every aspect of her mother's health, including diagnosis, medication, and outpatient resources. How lucky the patient was to have such a well-informed daughter, I thought.

Patients with schizophrenia are often out-of-touch with reality; patients with bipolar disorder may downplay their manic symptoms; patients with depression may try to hide their suicide attempts. Collateral information is vital when it comes to mental health care. Family as well as outpatient providers see the patient from another lens and are able to provide information that the inpatient team can utilize to provide the best quality of care and help the patient on the road to recovery.

For every patient, I would call his/her family member and ask these questions:

What’s been going on with the patient?

What is the patient like at his/her best?

Can the patient return home?

While some patients downright refused to have their family members contacted (with varying reasons), most of those I worked with agreed to provide consent when I explained that it would help them meet their treatment goals.

During the initial assessment, I would ask the patients to identify their support persons. I was surprised to learn that almost all the patients that I worked with had someone in their family -- father, mother, brother, sister, son, daughter, grandparents, even friends and neighbors – who had been helping them in the community.

Whenever I called one of these support persons to obtain information needed to help the patient, they were more than willing to help. They understood that it was important in their loved one’s treatment process. Some were truly involved in the treatment process, from day one of the onset of the patients’ illness. Some could list more than a handful of medications with correct dosage that the patient was taking. They provided such extensive information that it often seemed as though they were medical professionals.

The husband of a patient who had admitted herself to the hospital after days of hearing voices telling her to kill herself was furious when I called him. He was frustrated about his inability to help his wife, telling me that strict privacy laws prohibited him from helping her. Even as his wife’s caretaker and durable power of attorney, because the patient had yet to sign the consent form for him, he had no right to discuss her treatment information. When she finally did sign the consent form I called him. At the end of our conversation, he thanked me many times for letting him know that his wife was getting the help she needed.

This case was not uncommon. At the end of each call, I could always sense a feeling of relief and gratitude from the family members, especially when they learned their loved one was making progress.

While it can be frustrating to navigate the health care system, especially for mental health care, when done right, patients can benefit so much more in their inpatient mental health treatment process with the support of their family and community. If HIPAA laws were modified so that family could participate in the treatment more easily, patients would benefit. This was the most important lesson I learned from my field practicum. As a future social worker, I hope to continue learning about the mental health issues in our society and develop ways to make the treatment process more collaborative and fluid for the patients, family members, and care providers alike.

I also have come to shed my misperceptions on what is going on in a psychiatric hospital. A pleasant, safe environment to work in, I will certainly miss some of the patients I worked with.

Submitted by Timon of Athens aka Cledwyn O the Bulbs on June 5, 2014 - 3:34pm

Out-of touch with reality, you say? You mean your reality. If you are a social outsider and you think society is out to get you (which it often is, albeit the language we confer is contrived to conceal this), then you are delusional, paranoid, a schizophrenic.

If, on the other hand, you think madmen are out to get you (even though it is so statistically improbable that you will be attacked by someone labelled schizophrenic, it verges on impossible), you are, of course, in touch with reality, because the psychiatrists, that social class of individuals supposedly distinguished from the rest of us by their superior knowledge of human nature and the mind (an inversion of reality if ever there was one), have given their imprimatur to such irrationality, their approval investing it with a certain cachet no amount of logic could possibly dispel.

Yet on the historical scales of violence pertaining to the conflict between madman and society, the latter emphatically preponderates.

One of the great achievements of psychiatry is its ability to keep all eyes fixed on its victims. No matter how much violence the profession perpetrates, how many people it kills, mutilates, tortures, how many innocent people it detains, all eyes remain firmly fixed on the patients, whilst dangerous mental health workers (of which there are many) perpetrate atrocities on a scale unimaginable for so-called dangerous "mental patients" (of which there are few).

Organized psychiatry, with the abettal of the mass audio-visual media, has tapped into a rich vein of popular fear and paranoia which it manipulates for its own aggrandizement and in manufacturing continuing consent for its atrocities, a fear and paranoia that have now reached such a pitch that any arguments whose purpose is to demystify the supposed dangerousness of "seriously mentally ill" patients invariably gets scattered to the remotest corners of the debate by the maelstrom of emotions whipped up by psychiatry and a fear-mongering media. Lost amongst all this is any awareness of who poses the real danger.

As for her talk about detachment from reality, this is a view born of an ideology (mental supremacism) that splinters humanity apart into two groups that corresponds in character to supremacist ideologies in its unequal distribution of human worth and rights. In her other articles she talks of the supposed dangerousness of much untreated "mental illness", which takes for granted that there exists these abstract disease entities in urgent need of medical treatment and which are the causal mechanisms underlying a vast assortment of social and interpersonal ills. You seem pretty detached from reality yourself.

Psychiatrists and the rest of the community of the so-called sane are just as given to irrational thinking as anyone else, and can often be observed to withdraw into the world of delusion when reality refuses to accommodate their beliefs. Insanity and sanity are extremes that coexist in the same man, his mind swinging like a pendulum between the two according as to whether or not his emotions are balanced by his intellect, yet even then there are forces entirely beyond his control that determine the direction in which the pendulum swings, because a man cannot live within an age but entirely outside of its superstitions and prejudices, which we often unthinkingly inherit.

Irrationality is blind; we see its example clearly in others, but not in ourselves.

This is naive. There are well-meaning family members sure, but there are also family/ friends who will abuse the patient if given information or control without the patient's consent. It may be hard to believe given the "mental patients can't know what's best for them" or "madness is nonsensical" narratives, but sometimes those in emotional distress know or at least are "on to" what is best for them.

You know what it is like in a psych ward as a person with power. Being the "object" of discussion, treatment and surveillance is a whoooole other experience.

You're absolutely right in that there are those who abuse the power when it comes to a mentally ill patient's treatment process. I did run into those instances as an intern (Or family members who wanted nothing to do with the patient). And from conversations with people in my life who are not familiar with how mental health care works, I learned people erroneously believe that the "sane" always abuses the power against the mentally ill. Historically, this has been the case with institutionalization. Some family members were able to involuntarily commit another family member for being "crazy." In order to address this, there are now laws protecting the rights of the patients. Addington v. Texas or The Baker Act are some of the examples to show that the the individuals, when it comes to involuntary commitment, have gained more rights.

What I said above is why I was surprised to find from my experience at the hospital how supportive and compassionate people are to help their loved ones. Many of them spend hours a day taking care of the patients and make sure they get the adequate treatment/services in the community. As for the patients, I had many patients who expressed their gratitude towards their family members for the continued support. Some did understand that it takes a lot to receive proper care and some didn't--even when the latter was the case, the family members continue to support. One of them told me, "I know he might not seem to get it, but I know deep inside he gets that we're trying to best to support him."

This is your perspective as a member of staff . Have you ever been a patient in a unit - maybe not. You say they are safe are you sure about that because my experience is they are far from it . So yea as a member of staff this is your view however not the only view and yea for some patients they maybe safe but again not for all and I lucky in that I survived more from luck that anything else - literally. I am not exaggerating here in fact the opposite so yea every unit is different and some may or may not be safe but I can guarantee you that they all are not . I've been admitted to several so I'm not saying this by one short admission.